Medicare Compliance & Reimbursement
Payment Models:
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d... Read more
CMS Continues To Focus On Quality And Savings
Recent payment models offer primary care, behavioral health expanded options. Not only d... Read more
MIPS Quiz:
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability... Read more
Gauge Your Promoting Interoperability Savvy
Hint: Know the 4 PI objectives for PY 2024. If you think the Promoting Interoperability... Read more
Part B Coding Coach:
+99459: 5 FAQs Clarify How to Use This Expense Only Code
Here's what your physician's documentation needs to include. Since January 1, you can us... Read more
+99459: 5 FAQs Clarify How to Use This Expense Only Code
Here's what your physician's documentation needs to include. Since January 1, you can us... Read more
Clip and Save:
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ... Read more
Pocket This Primer On Informed Consent Forms
Pocket This Primer On Informed Consent Forms Critical: CMS revises interpretive guidance ... Read more
Reader Questions:
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b... Read more
Understand The Rules On Reinstatement After Exclusion
Question: When an individual is excluded from participating in the Medicare program b... Read more
Reader Questions:
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented tha... Read more
Budget:
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024... Read more
Find Out Top Factors In FY 2025 Budget Proposals
Funding for oversight and fraud enforcement are among the top budget requests. With 2024... Read more
Feds Finalize 2024 Funding
Tip: Understand these conversion factor changes already in effect. The feds finalized not... Read more
Tip: Understand these conversion factor changes already in effect. The feds finalized not... Read more
MIPS Quiz:
Evaluate How Well You Know The MIPS Improvement Activities
Tip: Understand what you need to get full credit in this performance category. For many... Read more
Evaluate How Well You Know The MIPS Improvement Activities
Tip: Understand what you need to get full credit in this performance category. For many... Read more
Part B Coding Coach:
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm... Read more
Make Radiation Treatment Management Codes Count
But use this one code sparingly, if ever. There are many moving parts to radiation treatm... Read more
Reader Questions:
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely... Read more
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely... Read more
Reader Questions:
Make Sure Your Health Apps And Wearables Are Compliant
Question: We use wearable devices and health apps to remotely monitor our patients wh... Read more
Make Sure Your Health Apps And Wearables Are Compliant
Question: We use wearable devices and health apps to remotely monitor our patients wh... Read more
Industry Notes:
Feds Offer Tools For Providers Affected By Cyberattack
If your practice is one of the many affected by the cyberattack against Change Healthcare... Read more
Feds Offer Tools For Providers Affected By Cyberattack
If your practice is one of the many affected by the cyberattack against Change Healthcare... Read more
Cybersecurity:
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl... Read more
CMS Offers Support Amidst Change Healthcare Attack
Crucial: Connect with your MAC and other payers for additional advice. If you're scrambl... Read more
HIPAA:
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r... Read more
OCR Warns Entities About Prioritizing Cybersecurity
Key stakeholders met to discuss ‘interconnectedness' of U.S. healthcare system. With r... Read more
MIPS Quiz:
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base... Read more
Measure Your Cost Category Knowledge
Tip: Understand there's more than one type of measure in Cost. Mastering the Merit-Base... Read more
Part B Coding Coach:
Debunk These 3 Common Allergy Coding Myths
Remember to report the cause of asthma exacerbation. With allergy season in full swing, y... Read more
Debunk These 3 Common Allergy Coding Myths
Remember to report the cause of asthma exacerbation. With allergy season in full swing, y... Read more
Pocket This ICD-10-CM Update For Asthma Coding
Changes are effective starting April 1. This past January, the Centers for Disease Contro... Read more
Changes are effective starting April 1. This past January, the Centers for Disease Contro... Read more
Industry Notes:
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele... Read more
Review MAC Guidance Before Sending That AAP Request
If you plan on applying for the Change Healthcare/ Optum Payment Disruption (CHOPD) accele... Read more
Industry Notes:
CMS Reopens 2023 MIPS EUC Application
If you've been impacted by the Change Healthcare cyberattack and you can prove it's affect... Read more
CMS Reopens 2023 MIPS EUC Application
If you've been impacted by the Change Healthcare cyberattack and you can prove it's affect... Read more
Prior Authorization:
Final Rule Aims To Improve Interoperability And Access To Care
Plus: Feds finalize new API requirements and a MIPS measure, too. After the pandemic reve... Read more
Final Rule Aims To Improve Interoperability And Access To Care
Plus: Feds finalize new API requirements and a MIPS measure, too. After the pandemic reve... Read more
Fraud & Abuse:
Feds Focus On Physicians In February Enforcement
Caution: The 2023 FCA settlement numbers may shock you. Per usual, the feds are off and r... Read more
Feds Focus On Physicians In February Enforcement
Caution: The 2023 FCA settlement numbers may shock you. Per usual, the feds are off and r... Read more
MIPS Quiz:
Test Your MIPS Smarts With This Quiz On The Basics
Tip: Know what your participation options include. Even though the Quality Payment Progr... Read more
Test Your MIPS Smarts With This Quiz On The Basics
Tip: Know what your participation options include. Even though the Quality Payment Progr... Read more
Part B Coding Coach:
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid... Read more
Tackle Thyroid Procedure Coding With These Tips
Check provider's wording to ensure understanding and claims success. When coding thyroid... Read more
Industry Notes:
Ensure Your Team Knows The Rules On Recoupment
Keep staff in the loop to avoid issues. Educating your personnel on how recoupment reques... Read more
Ensure Your Team Knows The Rules On Recoupment
Keep staff in the loop to avoid issues. Educating your personnel on how recoupment reques... Read more
HIPAA Round-Up:
Feds Follow Through With Final SUD Rule
Plus: See the latest settlement and regulatory updates. Even though we're only a few mon... Read more
Feds Follow Through With Final SUD Rule
Plus: See the latest settlement and regulatory updates. Even though we're only a few mon... Read more
Artificial Intelligence:
Discover How CMS Is Harnessing AI
Check out the agency's AI Playbook and what's ahead with emerging tech. As AI evolves and... Read more
Discover How CMS Is Harnessing AI
Check out the agency's AI Playbook and what's ahead with emerging tech. As AI evolves and... Read more
Expect AI To Be An Enforcement Tool — And Target
Experts warn about the perils of too much dependency on AI. You may find that the pros ou... Read more
Experts warn about the perils of too much dependency on AI. You may find that the pros ou... Read more
Part B Coding Coach:
Strengthen Your Modifier QW Savvy With These Steps
Don't forget to check the CLIA list when submitting a new lab test — every time. Whil... Read more
Strengthen Your Modifier QW Savvy With These Steps
Don't forget to check the CLIA list when submitting a new lab test — every time. Whil... Read more
Reader Question:
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of... Read more
Understand These CMN Basics
Question: My billing supervisor erased data that the doctor wrote on a certificate of... Read more
No Surprises Act:
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ... Read more
Feds’ Balance Billing Opus Continues To Evolve
Lawsuits, fee changes, and proposals abound. Since its inception, turmoil has surrounded ... Read more
EMTALA:
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co... Read more
Feds Offer Clarity On Providers’ Obligations Under EMTALA
Patient inquiries cause HHS and CMS to offer public education resources. As the courts co... Read more
Part B Coding Coach:
Bolster Colonoscopy Pre-Op Smarts With These Tips
Hint: Don't forget how comorbid conditions can impact pre-op E/M coding. Whether you're ... Read more
Bolster Colonoscopy Pre-Op Smarts With These Tips
Hint: Don't forget how comorbid conditions can impact pre-op E/M coding. Whether you're ... Read more
Reader Questions:
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager... Read more
Know the Difference Between EMRs and EHRs
Question: I've seen the acronyms EMR and EHR used interchangeably, but our IT manager... Read more
Reader Questions:
Consider This Insight On Qualifying for Home Visit
Question: One of the providers at our practice wants to bill 99350 when performing a ... Read more
Consider This Insight On Qualifying for Home Visit
Question: One of the providers at our practice wants to bill 99350 when performing a ... Read more
Industry Notes:
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin... Read more
Review Which Codes Require Invoices, MAC Warns
Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) remin... Read more
Industry Notes:
Compare Site Now Includes Physicians’ And Clinicians’ Procedure Volume Data
If you want to find utilization data on the number of procedures clinicians and physicians... Read more
Compare Site Now Includes Physicians’ And Clinicians’ Procedure Volume Data
If you want to find utilization data on the number of procedures clinicians and physicians... Read more
Medicare Advantage:
Bolster Managed Care Smarts With This Insight
Caution: Fix MA faux pas before OIG intervenes. With managed care on the HHS Office of I... Read more
Bolster Managed Care Smarts With This Insight
Caution: Fix MA faux pas before OIG intervenes. With managed care on the HHS Office of I... Read more
Part B Coding Coach:
Pocket This Assistant At Surgery Modifier Primer
Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary... Read more
Pocket This Assistant At Surgery Modifier Primer
Hint: Do not report modifiers 80 and AS together. An assistant surgeon may be necessary... Read more
Health IT:
Know The 10 Agencies That Impact Your Health IT
Get the scoop from transactions to privacy to enforcement. One thing is certain in feder... Read more
Know The 10 Agencies That Impact Your Health IT
Get the scoop from transactions to privacy to enforcement. One thing is certain in feder... Read more
Reader Question:
Get The Facts On EHR Standards For MIPS 2024
Question: We're a little confused by the updated information on EHR requirements for ... Read more
Get The Facts On EHR Standards For MIPS 2024
Question: We're a little confused by the updated information on EHR requirements for ... Read more
Reader Questions:
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t... Read more
Understand How The Part D Appeals Process Works
Question: As a Medicare Part D provider prescriber, our practice was curious about t... Read more
Industry Notes:
See The Latest Provider Enrollment Fee Increase
It's time to tighten your belt again. The costs of Medicare provider enrollment went up fo... Read more
See The Latest Provider Enrollment Fee Increase
It's time to tighten your belt again. The costs of Medicare provider enrollment went up fo... Read more
Industry Notes:
Submit PRF Attestations For RP 6 ASAP
If you received COVID-19 Provider Relief Fund (PRF) payments in the last half of 2022, the... Read more
Submit PRF Attestations For RP 6 ASAP
If you received COVID-19 Provider Relief Fund (PRF) payments in the last half of 2022, the... Read more
Industry Notes:
Add These QPP Policy Deadlines To Your Calendar
If you want to offer your two cents on specific Quality Payment Program (QPP) policies for... Read more
Add These QPP Policy Deadlines To Your Calendar
If you want to offer your two cents on specific Quality Payment Program (QPP) policies for... Read more
Compliance:
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ... Read more
CMS Reports Slight Error Rate Decrease For 2023
Documentation and medical necessity challenges top list of CERT woes. The feds made some ... Read more
Utilize This Handy CERT Tool
If you're stumped by CERT updates and are searching for all the latest and greatest on the... Read more
If you're stumped by CERT updates and are searching for all the latest and greatest on the... Read more
Here’s Why You Should Care About The CERT Report
Tip: Compare and contrast your internal issues against the national averages. Even if y... Read more
Tip: Compare and contrast your internal issues against the national averages. Even if y... Read more
CERT Quiz:
Test Your Smarts On MACs’ Role In CERT Review Process
Hint: It's complicated. As a Medicare provider, you may be accustomed to checking with th... Read more
Test Your Smarts On MACs’ Role In CERT Review Process
Hint: It's complicated. As a Medicare provider, you may be accustomed to checking with th... Read more
Part B Coding Coach:
Follow 3 Steps To Bolster Bleeding Control Reporting
Hint: Don't forget to review NCCI policies. During a surgical procedure or in the midst o... Read more
Follow 3 Steps To Bolster Bleeding Control Reporting
Hint: Don't forget to review NCCI policies. During a surgical procedure or in the midst o... Read more
Industry Notes:
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare... Read more
OCR Settles First Phishing Case
Caution: Analyze your risks, or pay the price. The benefits of technology to healthcare... Read more
Reimbursement:
Get Ready For 2024 With These Quality Updates
Pocket 7 top QPP and MSSP policies for next year. The 2023 rulemaking cycle was a banner... Read more
Get Ready For 2024 With These Quality Updates
Pocket 7 top QPP and MSSP policies for next year. The 2023 rulemaking cycle was a banner... Read more
Know These 2 QPP Policies That Didn’t Get Finalized
Hint: Just because something is proposed, doesn't mean CMS follows through on it. There w... Read more
Hint: Just because something is proposed, doesn't mean CMS follows through on it. There w... Read more
Enforcement:
OIG Targets Medicare Fraudsters in Latest Report
Post-COVID fallout continues to be a problem. If you need a reminder of why your practi... Read more
OIG Targets Medicare Fraudsters in Latest Report
Post-COVID fallout continues to be a problem. If you need a reminder of why your practi... Read more
Part B Coding Coach:
Add These 3 Tips To Your Medicare Billing Wheelhouse
Hint: Get clarification on Medicare's rules for E/M service encounters. Last August, th... Read more
Add These 3 Tips To Your Medicare Billing Wheelhouse
Hint: Get clarification on Medicare's rules for E/M service encounters. Last August, th... Read more
Reader Question:
Use This Advice For Calculating Anesthesia Charges Accurately
Question: Can you explain how to calculate and report anesthesia charges? When you ke... Read more
Use This Advice For Calculating Anesthesia Charges Accurately
Question: Can you explain how to calculate and report anesthesia charges? When you ke... Read more